术前化疗可减少吲哚菁绿在结直肠癌肝转移灶周围的蓄积，用于荧光引导手术。

Preoperative chemotherapy reduces the accumulation of indocyanine green around colorectal liver metastases for use in fluorescence-guided surgery.

作者信息

Bijlstra Okker D, Dijkhuis Tom H, Achterberg Friso B, Broersen Alexander, Dijkstra Jouke, Warmerdam Mats I, Henrar Rutger B, Burggraaf Jacobus, Crobach A Stijn L P, Swijnenburg Rutger-Jan, Kuppen Peter J K, Vahrmeijer Alexander L, Mieog J Sven D

机构信息

Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Department of Surgery, UMC, Location Vrije Universiteit, Amsterdam, the Netherlands.

出版信息

Surg Endosc. 2025 Sep 11. doi: 10.1007/s00464-025-12034-3.

DOI:10.1007/s00464-025-12034-3

PMID:40935937

Abstract

BACKGROUND

Near-infrared fluorescence imaging using intravenously administered indocyanine green (ICG) improves colorectal liver metastases (CRLM) surgery by enhancing lesion detection and real-time tumor margin assessment. However, ICG accumulates in hepatocytes around CRLM with high variance between patients. This study evaluates the effects of tumor and patient characteristics on ICG accumulation using a standardized imaging and analysis workflow.

METHODS

This single-center study included patients with CRLM who received 10 mg of ICG intravenously 24 h before surgery. Resected lesions were sliced in 5-10-mm-thick sections and immediately imaged for standardized fluorescence analysis. Fluorescence parameters were compared based on chemotherapy treatment, tumor response, tumor size and superficiality, and degree of steatosis. Associations between the patient and tumor characteristics and fluorescence parameters were determined while correcting for confounders.

RESULTS

Thirty-two lesions from 32 patients were analyzed. Lesions from chemotherapy-pretreated patients exhibited a lower mean signal fluorescence intensity (MSFI, 0.23 vs. 0.65 a.u.; p = 0.002) and signal-to-background ratio (SBR, 2.28 vs. 6.08; p < 0.001) than lesions from patients without pretreatment. Tumor size correlated positively with MSFI (p = 0.003), SBR (p = 0.02), and maximum intensity (p < 0.001). After correcting for the other characteristics, chemotherapy showed statistically significant association with the fluorescence parameters. The tumor superficiality, degree of steatosis, and response to chemotherapy had no statistically significant associations with the fluorescence parameters.

CONCLUSION

Neoadjuvant chemotherapy significantly lowers ICG accumulation around CRLM resulting in suboptimal contrast. To optimize fluorescence-guided surgery protocols for chemotherapy-pretreated patients, future research should focus on adjusting ICG dose and timing and exploring specific fluorescence tumor-targeting imaging agents.

摘要

背景

静脉注射吲哚菁绿（ICG）的近红外荧光成像通过增强病变检测和实时肿瘤边缘评估改善了结直肠癌肝转移（CRLM）手术。然而，ICG在CRLM周围的肝细胞中蓄积，患者之间差异很大。本研究使用标准化成像和分析流程评估肿瘤和患者特征对ICG蓄积的影响。

方法

本单中心研究纳入了CRLM患者，这些患者在手术前24小时静脉注射10mg ICG。将切除的病变切成5-10毫米厚的切片，并立即成像以进行标准化荧光分析。基于化疗治疗、肿瘤反应、肿瘤大小和表浅程度以及脂肪变性程度比较荧光参数。在校正混杂因素的同时，确定患者和肿瘤特征与荧光参数之间的关联。

结果

分析了32例患者的32个病变。化疗预处理患者的病变平均信号荧光强度（MSFI，0.23对0.65 a.u.；p = 0.002）和信号背景比（SBR，2.28对6.08；p < 0.001）低于未预处理患者的病变。肿瘤大小与MSFI（p = 0.003）、SBR（p = 0.02）和最大强度（p < 0.001）呈正相关。校正其他特征后，化疗与荧光参数具有统计学显著关联。肿瘤表浅程度、脂肪变性程度和化疗反应与荧光参数无统计学显著关联。